Journal of Gastrointestinal & Digestive System
Open Access

Abstract

Background: celiac sprue an immune-mediated inflammation of the small intestine caused by sensitivity to dietary gluten and related proteins in genetically sensitive individuals. In adults the presentation can be challenging for the physician. A patient presented with an erythematous tongue and lip which was painless and constantly exfoliating. Case presentation: A 30-years-old male from Bahirdar, Ethiopia presented with an erythematous tongue and upper lip which was exfoliating for more than 16 years. It was extending later to the lower lip upto the extent of obscuring the vermilion border. It started on the upper lip as a small reddish triangular and erythematous lesion which later started peeling. He had mild lactose intolerance but was not having serious abdominal complaints. He had a BMI of 20.6. He is now a university graduate and works in a government institution. He regularly complains severe fatigue and sleepiness for the past two years and a recent onset of forgetfulness and gait instability. His blood studies were normal. Peripheral morphology showed hypersegmented neutrophils and serum B12 levels were low. IgA tTG and IgA AGA levels were significantly elevated. He was then put on a strict gluten free diet and a parenteral cyanocobalamin. Within the first week he had significant improvement of the fatigue and his lips became less and less dry with complete healing after 3 months. Conclusion: atypical presentation of celiac sprue in adults warrants high degree of suscpicion and early diagnostic intervention to help detect such cases.

Biography

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